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NPI Code Detail

MEDICARE: LEAH MASHBURN MOT/ OTR,L

MEDICARE: LEAH MASHBURN MOT/ OTR,L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist5485OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15485OTHEROKOKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION

General Provider Information

NPI Number : 1861008195
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MASHBURN MOT/ OTR,L
Provider Business Mailing Address
First Line : 1605 S EUCALYPTUS AVE STE 200
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-5996
Country : US
Telephone Number : 918-608-1212
Fax Number : 918-289-2606
Provider Business Practice Location Address
First Line : 1605 S EUCALYPTUS AVE STE 200
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-5996
Country : US
Telephone Number : 918-608-1212
Fax Number : 918-289-2606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2020
Last Update Date : 11/27/2023

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Directions to “ LEAH MASHBURN MOT/ OTR,L” Practice Location

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